-
Question 1
Correct
-
A middle aged male arrives at the clinic due to chest pain and productive cough. The temperature is recorded to be 38CÖ¯. Radiological examination reveals lobar consolidation and pleurisy. Which of the following would be the best management plan for this patient?
Your Answer: Amoxicillin
Explanation:The mainstay of drug therapy for bacterial pneumonia is antibiotic treatment. The choice of agent is based on the severity of the patient’s illness, host factors (e.g., comorbidity, age), and the presumed causative agent. Lobar pneumonia is frequently associated with pneumococcus and Hemophilus infection. Amoxicillin can be effectively used in such cases.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 2
Incorrect
-
A 60-year-old female underwent pelvic surgery. She was given low molecular weight heparin (LMWH) after the procedure. After a week, she complained of sudden chest pain and difficulty in breathing. Her ECG and CXR were normal. What is the most suitable option for her?
Your Answer: Increase the dose of low molecular weight heparin and do CT. pulmonary angiography.
Correct Answer: Keep on low molecular weight heparin and do CT. pulmonary angiography.
Explanation:CT pulmonary angiography will decide the proper cause of her symptoms. Until that has happened LMWP should be continued.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 3
Correct
-
A 70-year-old male diagnosed previously with villous adenoma presented in the OPD with severe diarrhoea. Which of the following electrolyte or fluid imbalances is most commonly associated with such a condition?
Your Answer: Hypokalaemia
Explanation:Lower GIT fluid is rich in potassium. So, in the case of severe diarrhoea, potassium loss occurs leading to hypokalaemia. Loss of bicarbonate ions also occurs. Both of these disturbances will lead to hyperchloremic metabolic acidosis.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 4
Correct
-
A 25-year-old male presented in the emergency room with a history of loose stools which were bloody and mucoid for the last 2 to 3 months. The stools were also associated with abdominal cramps. He undergoes a colonoscopy after which he will start treatment. What is the most suitable drug in this case?
Your Answer: Mesalazine
Explanation:Symptoms are suggestive of inflammatory bowel disease. In this disease mesalazine is very effective as an anti-inflammatory drug.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 5
Correct
-
A 26-year-old man with a history of 'brittle' asthma is admitted with an asthma attack. High-flow oxygen and nebulised salbutamol have already been administered by the Paramedics. The patient is unable to complete sentences and he has a bilateral expiratory wheeze. He is also unable to perform a peak flow reading. His respiratory rate is 31/minute, sats 93% (on high-flow oxygen) and pulse 119/minute. Intravenous hydrocortisone is immediately administered and nebulised salbutamol given continuously. Intravenous magnesium sulphate is administered after six minutes of no improvement. These are the results from the blood gas sample that was taken after another six minutes:
pH 7.32
pCO2 6.8 kPa
pO2 8.9 kPa
What is the most appropriate therapy in this patient?Your Answer: Intubation
Explanation: -
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 6
Correct
-
A 34-year-old male has been brought to accident and emergency after being involved in a road collision. After his initial evaluation, his score on the Glasgow Coma Scale is 6. What is the most appropriate next step in his treatment?
Your Answer: Secure airway
Explanation:The appropriate next step in this patient’s treatment is to secure his airway.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 7
Correct
-
A 35-year-old man was brought to the ER with acute confusion. He's a known case of bipolar disorder under treatment with mood stabilizers. Blood investigations revealed lithium toxicity. A decision is made to start the patient on sodium bicarbonate. What is the rationale behind the use of sodium bicarbonate in this patient?
Your Answer: Increases urine alkalinity
Explanation:The rationale behind the use of sodium bicarbonate is that it increases the alkalinity of the urine promoting lithium excretion. The preferred treatment in severe cases would be haemodialysis.
Lithium is a mood-stabilizing drug used most commonly prophylactically in bipolar disorder but also as an adjunct in refractory depression. It has a very narrow therapeutic range (0.4-1.0 mmol/L) and a long plasma half-life being excreted primarily by the kidneys. Lithium toxicity generally occurs following concentrations > 1.5 mmol/L.
Toxicity may be precipitated by dehydration, renal failure, diuretics (especially Bendroflumethiazide), ACE inhibitors, NSAIDs and metronidazole.
Features of toxicity
Coarse tremor (a fine tremor is seen in therapeutic levels)
Hyperreflexia
Acute confusion
Seizure
ComaManagement
Mild-moderate toxicity may respond to volume resuscitation with normal saline
Haemodialysis may be needed in severe toxicity
Sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion. -
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 8
Incorrect
-
From the list of options, choose the most likely anaesthetic or analgesic cause of maternal hypotension.
Your Answer: Spinal anaesthetic
Correct Answer: Epidural anaesthetic
Explanation:In spinal anaesthesia, the needle parts the dura rather than tears it. In an epidural, however, the needle is meant to inject around the dura but may penetrate it by accident. Maternal hypotension is most likely to be caused by dural penetration during an epidural, as this is the generally intended procedure. Postdural puncture headache appears to be associated higher with a spinal than an epidural.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 9
Correct
-
A 28-year-old male complained of the following: nausea, vertigo, vomiting for longer than 30 minutes, tinnitus, and hearing loss in his left ear. Which of the following treatment options is most appropriate for this patient?
Your Answer: Cyclazine (1st line)
Explanation:Cyclizine and prochlorperazine are both used for the treatment of Meniere’s disease.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 10
Correct
-
A 40-year-old patient under treatment for gout gave a history of progressive weakness of his limbs over 2 months. He noticed that it was particularly difficult for him to get up from the toilet seat and to get out of his car. He also felt some tingling and numbness of his toes at night, which was distressing. He was taking several medications which included Ibuprofen, perindopril, colchicine, vitamin supplements, and indapamide.
On examination his pulse was 85/min, blood pressure was 140/90 mmHg and fundi revealed arteriovenous nipping. He had proximal lower limb weakness of 4/5 and absent ankle reflexes. Plantar reflexes were upgoing on both sides. His serum creatinine phosphokinase level was normal.
What is the most likely diagnosis?Your Answer: Colchicine toxicity
Explanation:The given clinical scenario is suggestive of myo-neuropathy and is most likely to be caused by colchicine toxicity.
It gives rise to subacute proximal muscle weakness and on occasions can lead to an acute necrotizing myopathy. Creatine phosphokinase may be normal or may be elevated.
Weakness resolves when the drug is discontinued but the neuropathic features remain.
Death is usually a result of respiratory depression and cardiovascular collapse.
Treatment is symptomatic and supportive, and the treatment for colchicine poisoning includes lavage and measures to prevent shock. -
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 11
Incorrect
-
A 12-year-old boy with emesis, dehydration, cold peripheries and deep breathing, has a blood glucose of 28 mmol/l. What would be the next best step in management?
Your Answer: 0.9% normal saline plus insulin
Correct Answer: Give normal saline 0.9%
Explanation:Normally blood glucose is filtered out by the kidneys, however as glucose levels exceed 180 mg/dL, the renal tubules become saturated and additional reabsorption is not possible. Glucose remains in the renal tubules, causing additional water and electrolytes to diffuse into the renal system and be excreted as urine (also known as osmotic diuresis). Excessive urine production results in electrolyte loss, and dehydration. Thus an important part of managing these patients is fluid replacement. Initially a litre of 0.9% NaCl over the 1st hour is given which may followed by either 0.45 or 0.9% NaCl, depending on the corrected serum sodium and the hemodynamic status of the patient.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 12
Correct
-
A 45-year-old male has presented at the hospital with an inoperable carcinoma and pain in his back. His pain has since been controlled well with morphine, but he soon starts vomiting. Morphine administration was ceased, and he was started on both fentanyl patches and metoclopramide. He soon develops stiffness in his neck and a fever. From the list of options, choose the cause of his symptoms.
Your Answer: Metoclopramide
Explanation:Metoclopramide side-effects are consistent with the patient’s symptoms: fever and stiffness of the neck. The other medications are not consistent with this symptom.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 13
Incorrect
-
A 17-year-old boy presents with tremors. Upon inquiry, the mother reports that the boy has a history of very aggressive episodes. She also reports that he has been hallucinating for some time. On examination, there were needle marks on his arm. What drug has been used?
Your Answer: Amphetamines
Correct Answer: Lysergic acid diethylamide (LSD)
Explanation:Psychedelic drugs, like LSD, bring on a state of altered consciousness, causing thought, audio, or visual changes. Low body temperature and tremors are associated with many drugs but closed-eye hallucinations are strongly associated with LSD and other psychedelic drugs.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 14
Incorrect
-
Around 30 patients have been admitted to the hospital following a suspected chemical attack in the city. The patients are extremely unwell, with symptoms of excessive salivation, lacrimation, diarrhoea, and emesis. Sarin gas was suspected as the most likely agent used in the attack. What is the mechanism of action of this chemical agent?
Your Answer: Anti-cholinergic
Correct Answer: Inhibition of acetylcholinesterase
Explanation:Sarin acts by inhibiting acetylcholinesterase.
Sarin gas is a highly toxic synthetic organophosphorus compound which causes inhibition of the enzyme acetylcholinesterase
Sarin gas is a highly toxic synthetic organophosphorus compound which causes inhibition of the enzyme acetylcholinesterase. This results in high levels of acetylcholine (ACh).The effects of excessive ACh can be remembered by the mnemonic DUMBELLS:
Diarrhoea
Urination
Miosis/muscle weakness
Bronchorrhea/Bradycardia
Emesis
Lacrimation
Salivation/sweatingOrganophosphate insecticide poisoning:
One of the effects of organophosphate poisoning is inhibition of acetylcholinesterase
Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD)
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
miosis, muscle fasciculation.Organophosphate poisoning is treated with the anti-muscarinic atropine.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 15
Incorrect
-
A middle-aged female has undergone axillary lymph node clearance after being diagnosed with breast carcinoma. She was stung by a bee and developed a swollen arm. What is the most probable mechanism behind this arm swelling?
Your Answer: Hypersensitivity reaction
Correct Answer: Lymphoedema
Explanation:Lymph nodes are necessary for the drainage of interstitial fluid to avoid swelling after some histamine reactions. In this case no lymph nodes are present and lymphoedema developed.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 16
Correct
-
An 18-year-old boy was admitted with severe pain and swelling of his scrotum following a kick to the groin. What is the most appropriate management that can be done at this stage?
Your Answer: Exploratory surgery
Explanation:The most worrying condition is testicular torsion and to exclude it exploratory surgery is required.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 17
Incorrect
-
A 18-year-old female is brought to the emergency department by her boyfriend. He is concerned that she may have taken an overdose of her mom's morphine sulphate pills after being depressed about her mother, who is dying of carcinoma of the breast.
Which of the following may point towards his suspicion?Your Answer: Hypertension
Correct Answer: Sweating
Explanation:Excessive sweating points towards a morphine overdose.
Morphine is considered the classic opioid analgesic with which other painkillers are compared. Like other medications in this class, morphine has an affinity for delta, kappa, and mu-opioid receptors.
Most commonly used in pain management, morphine provides major relief to patients afflicted with pain.Among the more common adverse effects of morphine use is constipation. Other side effects include nausea, vomiting, drowsiness, and confusion. Psychological and physical dependence may occur.
Other side effects include bronchospasm, angioedema, urinary retention, ureteric or biliary spasm, dry mouth, sweating, rash, facial flushing, vertigo, tachycardia, bradycardia, palpitations, orthostatic hypotension, hypothermia, restlessness, mood change, hallucinations, seizures (adults and children) and miosis, headache and allergic reactions (including anaphylaxis) and decreased libido or potency.
Raised intracranial pressure occurs in some patients. Muscle rigidity may occur with high doses. Elevated liver enzymes may occur due to biliary sphincter constriction. Large doses can lead to respiratory depression, circulatory failure, and coma.
Treatment of opioid overdose:
Initial treatment of overdose begins with supportive care.
Naloxone is a pure competitive antagonist of opiate receptors and has no agonistic activity. The drug is relatively safe and can be administered intravenous, intramuscular, subcutaneous or via the endotracheal tube.
Alternatively, nalmefene and naltrexone maybe considered. -
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 18
Incorrect
-
A 76-year-old woman attends the Emergency Department after knocking her shin on some furniture at home. She takes prednisolone for polymyalgia rheumatica. You examine her leg and find a pretibial laceration with a large skin flap. Which of the following is the best way to manage this?
Your Answer: Clean then suture the laceration with a 4/0 non-absorbable suture
Correct Answer: Clean then steristrip the laceration
Explanation:In young patients with good skin, pre-tibial lacerations may be sutured, usually with non-absorbable sutures that are removed after 7-10 days. In elderly patients with thin skin, or those on warfarin or steroids, the skin is frequently too fragile to suture. For these patients the wound should be thoroughly cleaned and meticulously steristripped to best aid skin healing. A non-adherent dressing and a light bandage can be applied and the patient should be encouraged to elevate the leg. Patients should be reviewed after a week. The laceration may take many months to heal and some require skin grafting procedures.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 19
Incorrect
-
A 25-year-old female presents to the emergency department with severe breathlessness and tinnitus. She is under treatment for asthma and depression with albuterol and amitriptyline respectively.
On examination, she seems agitated with a BP of 100/44, a pulse rate of 112 bpm, a respiratory rate of 30 cycles/min, and a temperature of 37.8'C.
An arterial blood gas performed reveals:
pH: 7.48 (7.36 - 7.44)
pO2: 11.2 kPa (11.3 - 12.6 kPa)
pCO2: 1.9 kPa (4.7 - 6.0 kPa)
Bicarbonate: 13 mmol/l (20 - 28 mmol/L)
What is the most probable diagnosis?Your Answer: Tricyclic antidepressant overdose
Correct Answer: Salicylate poisoning
Explanation:The blood gas analysis provided above is suggestive of a mixed respiratory alkalosis and metabolic acidosis characteristic of salicylate overdose.
Pathophysiology:
The direct stimulation of the cerebral medulla causes hyperventilation and respiratory alkalosis.
As it is metabolized, it causes an uncoupling of oxidative phosphorylation in the mitochondria.
Lactate levels then increase due to the increase in anaerobic metabolism. This, along with a slight contribution from the salicylate metabolites result in metabolic acidosis.Tinnitus is characteristic and salicylate ototoxicity may produce deafness. Other neurological sequelae include encephalopathy and agitation, seizures and CNS depression and coma. Cardiovascular complications include tachycardia, hypotension, and dysrhythmias (VT, VF, and asystole).
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 20
Incorrect
-
A young woman presents to the clinic with massive hematemesis. The episodes continue to occur despite initial measures. She is a chronic alcoholic. Which of the following steps would be the most important regarding the management of this patient?
Your Answer: Terlipressin
Correct Answer: Emergency banding
Explanation:Acute upper gastrointestinal bleeding is a common medical emergency which carries a hospital mortality in excess of 10%. The most important causes are peptic ulcer and varices. Varices are treated by endoscopic band ligation or injection sclerotherapy and management of the underlying liver disease.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 21
Correct
-
A 70-year-old male presents with chest pain. His past medical history includes hypertension and angina. He continues to smoke about 20 cigarettes per day despite being advised about lifestyle modifications.
Blood investigations obtained in the emergency department show:
Na+: 133 mmol/l
K+: 3.3 mmol/l
Urea: 4.5 mmol/l
Creatinine: 90 μmol/l
Which among the following is the most likely explanation for the abnormalities seen in the above investigations?Your Answer: Bendroflumethiazide therapy
Explanation:The blood investigations in this patient reveal hyponatremia as well as hypokalaemia. Among the options provided, Bendroflumethiazide therapy can cause the above presentation with the electrolyte disturbances.
Note:
– Spironolactone is a potassium-sparing diuretic that is associated with hyperkalaemia.
– Enalapril therapy can cause side effects of dizziness, hypotension, cough, and rarely a rash.
– Felodipine therapy can cause side effects of dizziness, headache, cough, and palpitations. -
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 22
Incorrect
-
A patient was given Penicillin G pre-operatively. Which of the following procedures was he waiting for?
Your Answer: Emergency sigmoid colectomy
Correct Answer: Splenectomy
Explanation:Asplenic patients are at a high risk of fulminant sepsis which is usually caused by capsulated organisms such as Streptococcus pneumonia, Haemophilus influenzas and Neisseria meningitides. So all the patients who are awaiting splenectomy should be given antibiotic prophylaxis. (Penicillin, if allergy to Penicillin, Clarithromycin)
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 23
Incorrect
-
A 45-year-old male admitted with acute onset retrosternal chest pain was diagnosed with unstable angina. Which of the following will mostly contribute to the acute risk stratification of this patient?
Your Answer: Electrocardiography
Correct Answer: Troponin testing
Explanation:Troponin testing is the most important investigation in risk stratification. Troponin positive patients should be referred for urgent coronary revascularization as troponin indicates cardiac cell damage.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 24
Incorrect
-
A 19-year-old football player was hit in his chest by an opponent. He became breathless and turned blue. What will be the initial management?
Your Answer: Start CPR
Correct Answer: Give oxygen
Explanation:As the patient is turning blue, giving oxygen will be the first priority in his management.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 25
Incorrect
-
A 7-month-old baby girl is admitted with poor feeding and irritability for 2 days. She is lethargic and persistently crying. Urine dipstick showed leukocytes. What is the single most important investigation to arrive at a diagnosis?
Your Answer: CXR
Correct Answer: Urine for C&S
Explanation:The clinical presentation and leucocytes on the urine dipstick is suggestive of a urinary tract infection. To confirm the diagnosis, urine should be sent for culture and sensitivity.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 26
Correct
-
A 30-year-old male came in with chills and dilated pupils, which were withdrawal signs and symptoms of a certain drug. Which of the following can cause above presentation?
Your Answer: Heroine
Explanation:Both cocaine and heroine withdrawal cause dilated pupils. Heroine withdrawal causes chills.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 27
Incorrect
-
A 21-year-old girl looking unkempt, agitated, malnourished, and nervous, came to the hospital asking for painkillers for her abdominal pain. She is sweating, shivering, and complains of joint pain. What could be the substance misuse here?
Your Answer: Ecstasy
Correct Answer: Heroin
Explanation:The appearance and complaints of this patient are strongly indicative of heroin abuse. The other substances listed usually present differently; cocaine and ecstasy users usually have a boost of confidence, someone under the effect of LSD is usually very sociable and relaxed, alcohol abusers might have symptoms like restlessness, hallucinations, shakiness, and insomnia.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 28
Correct
-
A 30-year-old male is brought to the emergency department following his collapse in a nightclub. His friends who accompanied him admit that, of recent, he has been using increasing amounts of cocaine. Which among the following is commonly associated with cocaine overdose?
Your Answer: Metabolic acidosis
Explanation:Metabolic acidosis is associated with cocaine overdose.
In overdose, cocaine leads to agitation, tachycardia, hypertension, sweating, hallucinations, and finally convulsions.
Metabolic acidosis, hyperthermia, rhabdomyolysis, and ventricular arrhythmias also occur.
Chronic use may be associated with premature coronary artery disease, dilated cardiomyopathy, and increased risk of cerebral haemorrhage.
There are 3 stages for acute cocaine toxicity:
Stage I: CNS symptoms of headache, vertigo, pseudo hallucinations, hyperthermia, hypertension.
Stage II: increased deep tendon reflexes, tachypnoea, irregular breathing, hypertension.
Stage III: Areflexia, coma, fixed and dilated pupils, hypotension, ventricular fibrillation, apnoea, and respiratory failure.Treatment:
– Airway, breathing, and circulation to be secured. The patient’s fever should be managed, and one should rule out hypoglycaemia as a cause of the neuropsychiatric symptoms.
– Cardiovascular toxicity and agitation are best-treated first-line with benzodiazepines to decrease CNS sympathetic outflow.
– The mixed beta/alpha blocker labetalol is safe and effective for treating concomitant cocaine-induced hypertension and tachycardia.
– Non-dihydropyridine calcium channels blockers such as diltiazem and verapamil have been shown to reduce hypertension reliably, but not tachycardia.
– Dihydropyridine agents such as nifedipine should be avoided, as reflex tachycardia may occur.
– The alpha-blocker phentolamine has been recommended but only treats alpha-mediated hypertension and not tachycardia. -
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 29
Incorrect
-
A 70-year-old female from a nursing home presented in the emergency department with complaints of headache, blurred vision and confused state for the last 4 to 5 days. On examination, she has several bruises on her head. Which of the following is the most likely cause behind the confused state of this patient?
Your Answer: Hyponatremia
Correct Answer: Subdural hematoma
Explanation:Bruises on her head are suggestive of a head injury. Confused state with a headache and blurred vision are due to a subdural hematoma.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 30
Incorrect
-
As the SHO of a hospital, you come across the lab report of a patient. It shows the following: glucose 4 mmol/L, K 5.2mmol/L, Na 129 mmol/L. How would you manage this patient?
Your Answer:
Correct Answer: Normal Saline 0.9%
Explanation:This patient’s blood glucose levels are within the normal range. From their lab report, they are suffering from milk hyperkalaemia and hypernatremia. Thus, normal saline 0.9 per cent is most appropriate in this case.
-
This question is part of the following fields:
- Emergency & Critical Care
-
SESSION STATS - PERFORMANCE PER SPECIALTY
